Electronic health records trim odds of hospital-acquired infections, other adverse events, AHRQ says
A recent study funded by Agency for Healthcare Research and Quality suggests that patients with fully electronic health records experienced fewer adverse events such as hospital-acquired infections.
In order to be considered a fully electronic EHR, "physician notes, nursing assessments, problem lists, medication lists, discharge summaries and provider orders are electronically generated," according to researchers.
Using 2012 and 2013 Medicare Patient Safety Monitoring System data, AHRQ examined outcomes for cardiovascular, pneumonia and surgery patients – specifically with regard to occurrence rates of 21 adverse events in four clinical domains: hospital-acquired infections, adverse drug events, general events (falls or pressure ulcers, for instance) and post-procedural events.
"To assess the role of EHRs in preventing adverse events, the researchers measured to what extent care received by patients in the 1,351 hospitals was captured by a fully electronic EHR," said Amy Helwig, MD, deputy director of AHRQ's Center for Quality Improvement and Patient Safety, and Edwin Lomotan, MD, medical officer and chief of clinical informatics at AHRQ's Center for Evidence and Practice Improvement, in a blog post.
The findings of the study, published in the Journal of Patient Safety, show that, of more than 45,000 patients at risk for nearly 350,000 adverse events in the study sample, 13 percent were exposed to fully electronic health records.
Among all patients examined in the study, the occurrence rate of adverse events was 2.3 percent, or 7,820 adverse events. Patients with EHRs, meanwhile, had 17 to 30 percent lower odds of any adverse event.
Helwig and Lomotan said that health IT has shown patient safety gains, but research to prove it has often looked at just one healthcare provider at a time.
"A question that remains unanswered is the impact of fully installed electronic health records systems used in multiple organizations," they wrote. "Another big question: can EHRs go beyond improving safety-related processes to actually preventing adverse events, such as potentially deadly hospital-acquired infections, from reaching patients?"
The findings from "Electronic Health Record Adoption and Rates of In-hospital Adverse Events" suggest hospitals with EHR can offer more coordinated care from admission to discharge to reduce the risk of patient harm.
They note, however, that adverse event odds varied by medical condition and type of event.
“For example, patients hospitalized for pneumonia and exposed to a fully electronic EHR had 35 percent lower odds of adverse drug events, 34 percent lower odds of hospital-acquired infections, and 25 percent lower odds of general events. Among patients hospitalized for cardiovascular surgery, a fully electronic EHR was associated with 31 percent lower odds of post-procedural events and 21 percent fewer general events," they wrote.
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Helwig and Lomotan caution that the AHRQ study raises a few questions.
“The findings showed a significant relationship between fully electronic EHRs and adverse drug event rates for patients hospitalized with pneumonia, but not for those with cardiovascular disease or needing surgery,” they wrote. “This may be due to the fact that certain high-alert medications, such as opioids, which are often associated with adverse drug events, were not included in the MPSMS measures."
Still, the authors said as more hospitals mature in their use of EHRs, those systems can play a key role in preventing adverse events.